If you rely on Covered California or ACA subsidies to afford health insurance, big changes are coming—and fast. President Donald Trump’s proposed “One Big Beautiful Bill” includes sweeping reforms that could reshape everything from your enrollment window to your premium assistance eligibility.
At Skyline Benefit, we help Californians navigate Covered California rules with expert support on tax filing, plan selection, and subsidy optimization. Here’s what you need to know now about the Trump Covered California changes in 2026, how they affect you, and how to prepare.
What Are the Trump Covered California Changes for 2026?
The Centers for Medicare & Medicaid Services (CMS), under the Trump administration, has introduced a new “Marketplace Integrity and Affordability Proposed Rule.” It includes strict new policies aimed at reducing improper enrollments, improving plan affordability, and limiting federal spending.
Here are the most significant proposals that could directly impact Covered California consumers in 2026:
Will You Need to Repay Old Premiums to Enroll Again?
Yes—CMS proposes that insurance carriers may now require you to repay past-due premiums before starting a new plan. If you missed payments under a prior plan, those balances may be rolled into your initial payment for new coverage.
This rule is designed to prevent people from skipping payments and reapplying later without financial accountability.
How Will DACA Recipients Be Affected by the New Rule?
Under Trump’s revised interpretation of “lawfully present,” DACA recipients will no longer be eligible for Covered California plans or subsidies starting in August 2025. This reverses Obama-era protections and reaffirms a 2012 definition that excludes DACA status.
If you or someone in your household is a DACA recipient, you’ll need to find alternative coverage by the end of the year.
What Happens If You Don’t File Your Federal Taxes?
Failing to file federal tax returns will now result in the loss of APTC subsidy eligibility after a two-year grace period. If you used subsidies but didn’t reconcile them with your tax return, your benefits will be terminated the following year.
Skyline Benefit is both a licensed health insurance broker and tax expert—we can help you file your taxes, reconcile your past APTC, and restore subsidy access.
Will the Open Enrollment Period Be Shorter in the Future?
Yes—starting in 2027, the Open Enrollment Period (OEP) will end on December 15, not January 15. This gives Californians just 6 weeks to apply or renew coverage each year.
Missing the deadline means waiting an entire year unless you qualify for a Special Enrollment Period (SEP).
What Is the $5 Premium Rule and How Will It Affect You?
Some people receive full subsidies that result in $0 monthly premium plans. Under the new 2025 proposal, these individuals must actively verify and renew their eligibility.
If not, they’ll be automatically re-enrolled with a $5 monthly premium. If this $5 isn’t paid within two months, your plan will be terminated by the end of the third month.
This rule is meant to ensure consumers remain engaged and responsible for their coverage.
Will Special Enrollment Periods (SEPs) Be Harder to Qualify For?
Yes—CMS proposes to require pre-enrollment verification for all SEP applications. That means no more immediate plan access unless you provide proper documentation of qualifying life events (job loss, move, etc.).
Also, the monthly SEP available to households earning under 150% of the FPL will be removed. This is to prevent misuse by brokers or enrollees and reduce risk pool instability.
Can Carriers Refuse to Cover Certain Services?
Trump’s 2026 rules would prohibit sex-trait modification surgeries from being treated as an Essential Health Benefit (EHB). This means plans will not be required to cover them—though private plans may choose to.
Furthermore, this rule aligns EHBs more closely with what’s offered in most employer-sponsored plans.
Will Premiums and Cost-Sharing Rules Be Adjusted?
Yes—new adjustments to the Premium Adjustment Percentage (PAPI) will impact:
- Maximum annual out-of-pocket costs
- Required contribution percentages
- Premium caps and adjustments by income
However, these changes will take effect by plan year 2026 and may impact your plan affordability and cost-sharing structure.
Need Help Understanding the Trump Covered California Changes for 2026?
Skyline Benefit is a certified insurance agency with Covered California, we specialize in Covered California enrollment, subsidy support, and tax reconciliation. We don’t just help you find a health plan—we make sure it’s the right one, at the right price, with your tax and legal standing in full compliance.
Schedule a consultation today. Call us at: (714) 888-5112